Health inspection·September 21, 2022

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, staff interviews, and policy review, the facility failed to ensure staff provide appropriate care and services to promote healing and prevent cross contamination of pressure ulcers for 1 of 1 sampled residents with pressure ulcers. (Resident #43) Residents Affected - Few The findings include: A review of Resident #43's medical record was conducted which revealed she had a stage 3 pressure ulcer on her sacrum. An observation of wound care for Resident #43 was conducted on 9/20/2022 at 12:51 PM with Employee A (Licensed Practical Nurse). Employee A gathered supplies for the wound care from the treatment cart to include a bottle of wound cleanser dated 9/3/2022, took the supplies to the resident's room, and placed them on the over bed table with no barrier on the table. Employee A washed her hands and applied clean gloves, removed the old dressing from the resident's sacrum, removed the bottle of wound cleanser from the over bed table and set it on the resident's bed, then picked up the bottle of wound cleanser and used it to clean the wound. Employee A then applied gauze with Iodosorb to the wound bed, then removed her gloves and applied clean gloves and applied the adhesive dressing to the wound. Employee A did not wash her hands and change gloves after removing the soiled dressing and did not wash hands after cleansing the wound. After completing the wound care, Employee A returned the wound cleanser to the treatment cart by placing it back in the cart. She did not sanitize the bottle of wound cleanser before placing it back in the cart. An interview was conducted with Employee A on 9/20/2022 at 12:59 PM. She stated the bottle of wound cleanser she used was used on multiple residents and they use bleach wipes to clean the bottle. She then removed the bottle of wound cleanser from the treatment cart and cleansed the bottle of wound cleanser with a bleach wipe before placing it back in the same area of the treatment cart. Review of the facility policy for Clean Dressing Change (revised 1/5/2022) revealed it is the policy of this facility to provide wound care in a manner to decrease the potential for infection and/or cross contamination. Multi-use wound care supplies will be maintained as clean after initial use. Set up a clean field on the over bed table with needed supplies for wound cleansing and dressing application. Place a disposable cloth or linen saver on the over bed table. Place only the supplies to be used per wound on the clean field at one time. Wash hands and put on clean gloves, loosen the tape and remove existing dressing, remove gloves pulling inside out over the dressing and discard, wash hands and put on clean gloves, cleanse the wound as ordered, wash hands and put on clean gloves, apply topical ointments or creams and dress the wound as ordered, secure the dressing. An interview was conducted with the Director of Nursing (DON) on 9/20/2022 at 1:33 PM. She stated (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 105395 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Nursing and Rehabilitation Center 1001 Mar-Walt Drive Fort Walton Beach, FL 32547 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)